Evaluation of Fever in the Immediate Postoperative Period in Patients Who Underwent Total Joint Arthroplasty

Athanassious, Christian; Samad, Adil; Avery, Anthony; Cohen, Jason; Chalnick, David

doi:10.1016/j.arth.2011.02.019

Cited by 40 publications

(54 citation statements)

References 7 publications

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“…Post-operative fever has been postulated to be secondary to the inflammatory cascade initiated by surgery, 2,29 the physiologic stress of surgery, 30,31 the presence of infectious processes, as well as non-infectious processes such as DVT, phlebitis, atelectasis and acute post-operative anemia. 4,27,32 These post-operative febrile events initiate a generalized fever workup in adult and paediatric orthopaedic patients following a myriad of procedures, even in the absence of patient symptoms. However, the execution of a generalized fever workup increases the cost of hospitalization and potentially prolongs hospital stay, despite having low diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

“…Febrile events during the first 3 post-operative days, in the absence of localizing symptoms, do not merit a diagnostic workup as they occur in 50-87% of patients. 4,6,7,14,17,20,23 Ishii et al found that post-operative fever in the first 3 days following total joint arthroplasty is exceptionally common. 9 The rate of post-operative fever drops precipitously after that, but does not become zero.…”

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confidence: 99%

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Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Ashley

Spiegel

Cahill

et al. 2017

J Orthop Surg (Hong Kong)

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Background: Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness. Methods: Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis. Results: Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950. Conclusion: The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Ashley

Spiegel

Cahill

et al. 2017

J Orthop Surg (Hong Kong)

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“…There was no correlation between fever and deep infection after arthroplasty. 9 Overall, reported rates of postoperative bacteraemia have been low, and blood cultures are of limited utility in patients with early postoperative fever. 2,5,7,[20][21][22][23] A single blood culture set is valued at US$31.9 at our hospital, and the price of processing is estimated to be $70 to $230, and thus the cost of identifying a single patient with bacteraemia may be as high as $3000.…”

Section: Discussionmentioning

confidence: 99%

“…2,[5][6][7] After elective orthopaedic arthroplasty, early postoperative fever in otherwise well patients is generally benign, and thus blood cultures are of low utility. [8][9][10][11][12][13][14][15] Nonetheless, patients with femoral neck fractures are often old and decrepit and have co-morbidities that predispose to impaired healing and infection. This leads to low thresholds for blood cultures.…”

Section: Introductionmentioning

confidence: 99%

Blood Cultures for Evaluation of Early Postoperative Fever after Femoral Neck Fracture Surgery

Sivakumar

Vijaysegaran

Ottley

et al. 2012

J Orthop Surg (Hong Kong)

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purpose. To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. Methods. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥38ºC. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. results. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. conclusion. The risk of bacteraemia in patientsBlood cultures for evaluation of early postoperative fever after femoral neck fracture surgery 2012;20(3):336-40 with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.

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“…Additional suggestive findings are wound dehiscence, joint warmth, redness, or swelling. Fever may be present but not to necessarily [55]. A complete examination of the joint is necessary.…”

Section: Infectionmentioning

confidence: 99%

Painful knee arthroplasty: current practice

Cottino

Rosso

Pastrone

et al. 2015

Curr Rev Musculoskelet Med

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Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.

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Evaluation of Fever in the Immediate Postoperative Period in Patients Who Underwent Total Joint Arthroplasty

Cited by 40 publications

References 7 publications

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Blood Cultures for Evaluation of Early Postoperative Fever after Femoral Neck Fracture Surgery

Painful knee arthroplasty: current practice

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